Issue 149: july 2011

fect all chil dren. How ever, the

cir cum stances that lead to a child be com -

ing looked after (loss, be reave ment,

trauma, lack of con ti nu ity in car ing re la -

tion ships,  or  the  ac cu mu la tion  of

stress ors)  com bined  with  the  ex pe ri ence

of being looked after tend to have a con -

sid er able im pact on the men tal health and

wellbeing of a child or young per son. It is

not sur pris ing that young peo ple who are

looked after high light the im por tance of

con trol and choice when seek ing and re -

ceiv ing  sup port  and  of  con ti nu ity  in

re la tion ships  with  care-giv ers  and  with

friends (Stan ley, 2007). Chil dren who are

looked after are more likely to ex pe ri ence 

poor men tal health and de velop men tal

health prob lems, com pared with the gen -

eral pop u la tion of chil dren (Meltzer et al.,

2004). Men tal health prob lems are just as

prev a lent among those who are looked

after and liv ing at home with their families

as among those who are in foster care or

residential care.  

Poor men tal health in chil dren who are 

looked after tends to be man i fested in

com plex ways which can dif fer greatly

from child to child and which may not

con sti tute a readily de fin able set of symp -

toms. For this group of chil dren, the

ap pro pri ate start ing point may not cen tre

on  es tab lish ing  a  di ag no sis  using  cat e gor i -

cal mod els of dis or der but may emerge

from con cerns elic ited by the child’s be -

hav iour.  Ex pe ri enced  prac ti tio ners  sug gest 

that it is more use ful with this pop u la tion

to work with con cepts of change, trauma,

re sil ience, loss and at tach ment and to take 

an eco log i cal view of the pre sent ing be -

hav iour  that  sit u ates  that  be hav iour  within 

the child’s cur rent and past ex pe ri ences.

These  are  sig nif i cant  con sid er ations  in  re -

la tion to the types of ser vice mod els and

in ter ven tions that are likely to be useful in

addressing mental health in the context of

the care system.  

Where chil dren re quire treat ment and

care,  ex pe ri ence  sug gests  that  ther a peu tic 

work with the looked-after pop u la tion is

not  ad e quately  de liv ered  through  ‘stan -

dard’ ar range ments for spe cial ist child and 

ad o les cent  men tal  health  pro vi sion.  This  is 

a ques tion partly of how ser vices are or -

gan ised  and  re sources  al lo cated,  wait ing

times from re fer ral to as sess ment, and

ser vices being pro vided in clin i cal set tings

that are per ceived as stig ma tis ing by chil -

dren and young peo ple (Barbour et al.,

2006). It also stems more fun da men tally

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Child

Family

Community

Secure early

relationships

At least one

good parent-

child relationship

Wider social

network

Positive attitude

Affection

Good housing

Problem-solving

skills

Clear, consistent 

discipline

High standard of

living

Communication

skills

Support for

education

Positive school

ethos

“Easy”

temperament

Supportive

long-term

relationship

Positive peer

relationships

Capacity to

reflect and learn

from experience

Range of

opportunities for 

pro-social

activities

Healthy living,

eg. diet, activity

levels

Opportunity to

be heard/

participate/

exercise control

Safe

environments

Table 2

Pro tec tive fac tors for men tal health and wellbeing

 

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from  the  dif fer ent  con cep tual  frame works 

on which care ser vices and treat ment ser -

vices are con structed (McCollam &

Wood house,  2007).

Pol icy  con text

The men tal health of chil dren and young

peo ple:  A frame work for pro mo tion, pre ven -

tion and care (FPPC)  (Scot tish  Ex ec u tive,

2004) makes bold state ments about the

im por tance of the men tal health and

wellbeing of all chil dren and young peo ple

as a shared re spon si bil ity across sec tors.

The FPPC ac knowl edges that some

groups of chil dren and young peo ple are

at height ened risk of poor men tal health

and those who are or have been looked

after are among these. Spe cific ac tion is

re quired to pro mote the men tal health of

this group, to pre vent the de vel op ment of 

prob lems and ad dress the needs of those

in dis tress through: 

• The pro vi sion of train ing and con sul ta -

tion on emo tional and men tal health

needs for res i den tial care work ers and

fos ter carers;  

• Ac ces si ble  and  con fi den tial  sup port  for

chil dren and young peo ple who are

feel ing  trou bled;   

• Ex plicit ar range ments within each NHS 

Child  and  Ad o les cent  Men tal  Health

Ser vice (CAMHS) team in clud ing re fer -

ral pro to cols for looked-after chil dren

and ar range ments for care plan ning and 

re view;   

• Li ai son  be tween  spe cial ist  CAMHS  and

looked-after  ser vices,  in clud ing

multi-agency plan ning and com mis sion -

ing to en sure the de vel op ment and

de liv ery  of  ac ces si ble  and  ap pro pri ate

men tal health re sponses for chil dren

and young peo ple in local au thor ity care. 

The Scot tish Needs As sess ment

Programme (SNAP) work ing group sur -

veyed the ex pe ri ences of a wide range of

pro fes sion als  work ing  with  chil dren,

young peo ple and fam i lies and iden ti fied

some key con cerns among the res i den tial

care workforce. These in cluded the high

per ceived need for train ing on men tal

health, better ac cess to ad vice and sup -

port to en able them to care ap pro pri ately

for chil dren and young peo ple in dis tress

and the need for spe cial ist ser vices to be

more flex i ble to pro vide ‘out reach’ sup -

port to fit the con text in which the child is 

being sup ported (Barbour et al., 2006).

The Ex traor di nary  Lives re view of care

for chil dren who are looked after drew at -

ten tion to the health in equal i ties

ex pe ri enced by this group of chil dren and

young peo ple and re cog nised that achiev -

ing and main tain ing good health is a

pri or ity for them and their carers. To this

end, the re view rec om mends that de tails

about a child’s health are fully re corded

and the in for ma tion passed on quickly to

new carers if the child moves place ment.

Care pro vid ers should be aware of the in -

creased like li hood that some chil dren and

young peo ple who are looked after away

from home may de velop men tal health

prob lems, and know how to gain ac cess to 

ap pro pri ate help at an early stage. The re -

view high lights the im por tance of

co or di nat ing  local  ser vices  to  help

looked-after chil dren and young peo ple

get the best pos si ble health care (So cial

Work In spec tion Agency, 2006). 

The  na tional  re view  of  ed u ca tional  and

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